PT  - JOURNAL ARTICLE
AU  - Camille Rolland-Debord
AU  - Côme Bureau
AU  - Marc Clavel
AU  - Sebastien Perbet
AU  - Nicolas Terzi
AU  - Achille Kouatchet
AU  - Thomas Similowski
AU  - Alexandre Demoule
TI  - Risk factors and prognostic impact of patient-ventilator asynchrony in mechanically ventilated patients. A prospective study
AID  - 10.1183/13993003.congress-2015.OA4473
DP  - 2015 Sep 01
TA  - European Respiratory Journal
PG  - OA4473
VI  - 46
IP  - suppl 59
4099  - http://erj.ersjournals.com/content/46/suppl_59/OA4473.short
4100  - http://erj.ersjournals.com/content/46/suppl_59/OA4473.full
SO  - Eur Respir J2015 Sep 01; 46
AB  - Rational: Patient-ventilator asynchrony (PVA) is a mismatch between patient and ventilator times during mechanical ventilation (MV). The few studies that have investigated their impact have suggested that high prevalence of asynchronies is associated with prolonged duration of MV.Study aims: to quantify prevalence of PVA by electromyographic activity of the diaphragm (Edi), identify risk factors for PVA, describe their consequences on the outcome.Methods: Ancillary study of a randomized controlled trial comparing neurally ventilator adjusted assist to pressure support ventilation in 127 patients. Asynchronies were quantified at H12, 24, 36 and 48 on recordings of flow, airway pressure and Edi. Asynchrony index (AI) was defined as number of asynchrony events/total respiratory rate x100. Severe asynchrony was defined as an AI >20%.Results: Median AI was 24 (0-69). Prolonged and short cycles were the main asynchronies (respectively 37% and 31% of asynchronies) followed by double-triggering (21%). No significant difference was observed in term of age, SAPS II, gender, dyspnea, comfort scale, ATICE between patients with an AI >20% and those with an AI <20%. Length of stay was significantly lower in patients with an AI <20% as compared to those with a high AI at H12 (31.2 ± 11.0 vs 36.8 ± 16.8, p= 0.047). So was extubation delay (12.7 ± 8.1 vs 16,4 ± 11.3; p = 0.04). D28 mortality was similar in the two groups.Conclusion: Based on Edi recording, prevalence of PVA is high. Among all factors, none was associated with an increased PVA. Increased patient-ventilator asynchrony at H12 was associated with prolonged duration of mechanical ventilation and length of stay.